US20040167542A1 - Target depth locators for trajectory guide for introducing an instrument - Google Patents
Target depth locators for trajectory guide for introducing an instrument Download PDFInfo
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- US20040167542A1 US20040167542A1 US10/370,083 US37008303A US2004167542A1 US 20040167542 A1 US20040167542 A1 US 20040167542A1 US 37008303 A US37008303 A US 37008303A US 2004167542 A1 US2004167542 A1 US 2004167542A1
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- trajectory
- locators
- imagable
- instrument
- skull
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/10—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges for stereotaxic surgery, e.g. frame-based stereotaxis
- A61B90/11—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges for stereotaxic surgery, e.g. frame-based stereotaxis with guides for needles or instruments, e.g. arcuate slides or ball joints
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3403—Needle locating or guiding means
- A61B2017/3405—Needle locating or guiding means using mechanical guide means
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
Definitions
- This document relates generally to trajectory guides for steering an instrument, and more specifically, but not by way of limitation, to target depth locators for a trajectory guide.
- Neurosurgery sometimes involves inserting an instrument through a burr hole or other entry portal into a subject's brain toward a target region of the brain. Because of the precision needed to reach the target, while avoiding nearby structures that are often critical to brain function, stereotactic instrument guidance is sometimes provided.
- a stereotactic headframe is mounted about the patient's skull.
- a trajectory guide is mounted to the headframe to provide an instrument-guiding trajectory through the burr hole and aimed toward the target.
- a trajectory guide is locally mounted directly to the skull in or about the burr hole.
- the skull-mounted trajectory guide also provides an instrument-guiding trajectory through the burr hole and aimed toward the target.
- an image-guided workstation may be used to provide navigational guidance to the neurosurgeon, such as by displaying preoperative images of the subject to assist the neurosurgeon in planning or performing the procedure.
- the present inventors have recognized that a neurosurgeon using a trajectory guide to introduce an instrument to a target may want to confirm that the instrument has actually reached the depth of the desired target. For these and other reasons, which will become apparent upon reading the following detailed description and viewing the drawings that form a part thereof, the present inventors have recognized an unmet need for trajectory guide systems, devices, and methods allow confirmation that an instrument being introduced has actually reached the desired target.
- FIG. 1 is a perspective view schematic diagram illustrating generally an example of portions of a stereotactic apparatus.
- FIG. 2 is a top perspective view illustrating an example of portions of the stereotactic apparatus in more detail.
- FIG. 3 is a perspective view schematic diagram that illustrates generally an example of the stereotactic apparatus with the positioning assembly re-oriented by 45° with respect to the position illustrated in FIG. 1.
- FIG. 4 is a side perspective view schematic diagram illustrating generally an example of portions of the stereotactic apparatus in which the trajectory is coincident with an axis extending substantially concentrically through and orthogonal to a burr hole or other entry portal to or about which a mounting base is secured.
- FIG. 5 is a side perspective view schematic diagram illustrating generally an example of portions of the stereotactic apparatus in which the trajectory has been tilted at an angle to an axis extending substantially concentrically through and orthogonal to a burr hole or other entry portal to or about which a mounting base is secured.
- FIG. 6 is a schematic diagram illustrating conceptually a view of reticles and an instrument being introduced along the guided trajectory, such as would be seen on an imaging system used to confirm placement of the instrument at the desired depth along the trajectory.
- FIG. 7A is a schematic diagram that illustrates conceptually a side view of the reticles and the instrument, such as would be seen on the imaging system confirming placement of the instrument at the desired depth along the trajectory.
- FIG. 7B is a schematic diagram that illustrates conceptually a side view of the reticles and the instrument, such as would be seen on the imaging system confirming placement of the instrument at the desired depth along the trajectory.
- FIG. 8 is a schematic diagram illustrating generally portions of one embodiment of an apparatus in which the side arms are adjustably coupled to the radial arms.
- FIG. 9 is a flow chart illustrating generally one example of a technique for performing instrument depth confirmation during an image-guided neurosurgery procedure.
- FIG. 10 is a top view schematic diagram illustrating generally an alternative example of a positioning assembly that includes a semicircular or C-shaped indexing ring.
- FIG. 11 is a schematic diagram illustrating generally a perspective view of a trajectory guide assembly including an adjustable-height stage.
- FIG. 12 is a schematic diagram illustrating generally an alternative trajectory guide assembly including an apparatus for receiving and seating a positioning assembly bearing imagable depth confirmation locators.
- FIG. 13 is a schematic diagram illustrating generally another alternative trajectory guide assembly including an apparatus for receiving and seating a positioning assembly that includes imagable depth confirmation locators.
- FIG. 14 is a schematic diagram illustrating generally a first ball-and-socket type trajectory guide assembly that includes an apparatus for receiving and seating a positioning assembly that includes imagable depth confirmation locators.
- FIG. 15 is a schematic diagram illustrating generally a second ball-and-socket type trajectory guide assembly that includes an apparatus for receiving and seating a positioning assembly that includes imagable depth confirmation locators.
- FIG. 16 is a schematic diagram illustrating generally an example of a custom-formed trajectory guide that includes an apparatus for receiving and seating a positioning assembly that includes imagable depth confirmation locators.
- FIG. 1 is a perspective view schematic diagram illustrating generally, by way of example, but not by way of limitation, portions of a stereotactic apparatus 100 .
- the stereotactic apparatus 100 includes a mounting base 102 and a trajectory guide assembly 104 coupled to the mounting base 102 .
- the mounting base 102 is configured, in this example, to be secured in or about a burr hole in a subject's skull (or in or about another entry portal in another surface of an animate or inanimate object).
- the trajectory guide assembly 104 is adjustably orientable with respect to the mounting base 102 .
- the trajectory guide assembly 104 provides an adjustably orientable trajectory 106 .
- a positioning assembly 110 is coupled to the trajectory guide assembly 104 .
- the positioning assembly 110 carries imagable locators, such as imagable reticles 112 A-B (also referred to as “reticules”). Such imagable locators are used for confirming, using an imaging system to locate the locators, that the instrument 108 introduced along the trajectory 106 has reached a desired depth or other desired location corresponding to a desired target.
- imaging systems include, by way of example, but not by way of limitation, magnetic resonance (MR) imaging systems, computed tomography (CT), positron emission tomography (PET), and single photon emission computed tomography (SPECT), X-ray, fluoroscopy, or other radiographic imaging systems, ultrasonic imaging systems, and the like.
- MR magnetic resonance
- CT computed tomography
- PET positron emission tomography
- SPECT single photon emission computed tomography
- X-ray X-ray
- fluoroscopy or other radiographic imaging systems, ultrasonic imaging systems, and the like.
- the positioning assembly 110 is coupled to the trajectory guide assembly 104 such that a “sighting” line 114 , conceptually defined between centers of reticles 112 A-B.
- the sighting line 114 intersects the trajectory 106 —even as the trajectory guide assembly 104 is adjusted, with respect to the fixed mounting base 102 , to orient the trajectory 106 .
- the positioning assembly 110 further includes at least one positioner, such as scaled slots 116 A-B.
- a scale accompanying each of the respective slots 116 A-B includes viewable indicia providing depth information.
- the slots 116 A-B permit adjustment of the locations of the reticles 112 A-B such that the sighting line 114 can be adjusted to intersect the trajectory 106 at different points.
- the sighting line 114 is adjusted to intersect the trajectory 106 at a depth that corresponds to a desired target location in the subject's brain.
- the user can confirm whether the instrument 108 has reached the desired target depth, along the trajectory 106 . More particularly, the instrument 108 will have reached the desired target depth along the trajectory 106 when the imaging system detects the tip (or other imagable indicator locatable by the imaging system) on the instrument 108 as being coincident with the sighting line 114 .
- the positioning assembly 110 carrying the reticles 112 A-B for confirming the depth of the instrument 108 , is coupled to an adjustably orientable trajectory guide assembly 104 that adjusts the trajectory 106 (for introducing the instrument 108 ) by separately adjusting (1) a rotation about an axis that is concentric and orthogonal to the burr hole or other entry portal in or about which the mounting base 102 is secured, and (2) a tilting of an instrument guide lumen (or lumens) to adjust an angle between the instrument trajectory 106 and the concentric axis.
- the trajectory guide assembly 104 rotatably rides on a platform ring 118 , provided by the mounting base 102 .
- the trajectory guide assembly 104 further includes a “saddle” 120 riding along a semispheric arc-shaped surface 122 . This provides the tilting adjustment of the angle of the trajectory 106 with respect to the concentric axis.
- a suitable trajectory guide assembly 104 and mounting base 102 is described in Skakoon et al.
- the stereotactic apparatus 100 provides multiple trajectories 106 , such as by using a multilumen insert, one example of which is described in the above-incorporated Skakoon et al. U.S. patent application Ser. No. 09/828,451.
- the positioning assembly 100 is detachably mounted to the trajectory guide assembly 110 using an indexing circular or semicircular ring 123 .
- the ring 123 is mounted to the trajectory guide assembly 104 substantially concentrically to the trajectory 106 provided by the trajectory guide assembly 104 .
- elongated radial arms 124 A-B radially extend out from opposing sides of the outer circumference of the ring 123 , such that a line 126 (which is conceptually defined to extend longitudinally through both of the longitudinally-aligned radial arms 124 A-B) orthogonally intersects the trajectory 106 .
- elongated side arms 128 A-B extend orthogonally downward from the outer ends (i.e., the ends that are located away from the ring 123 and the trajectory guide assembly 104 ) of the respective radial arms 124 A-B.
- the side arms 128 A-B are oriented, with respect to the respective radial arms 124 A-B, such that the side arms 128 A-B longitudinally extend parallel to the trajectory 106 .
- the outer ends (i.e., away from the respective radial arms 124 A-B) of the side arms 128 A-B carry disk-shaped imagable reticles 112 A-B, or other imagable locators.
- the side arms 128 A-B each include respective slots 116 A-B into which sliding end blocks 117 A-B of the radial arms 124 A-B are inserted. This permits the side arms 128 A-B to slide up and down with respect to the radial arms 124 A-B, for adjusting the reticles 112 A-B toward and away from the radial arms 124 A-B.
- the slots 116 A-B include respective depth scales or other indicia. This permits adjustment of reticles 112 A-B such that the sighting line 114 corresponds to the desired target depth along the trajectory 106 .
- a locking mechanism such as thumbscrews 130 A-B or the like, extends through each one of the slots 116 A-B.
- this side arms 128 A-B to be secured with respect to the radial arms 124 A-B.
- the radial arms 124 A-B and the side arms 128 A-B position the reticles 112 A-B on opposing sides of the subject's skull, into which the trajectory 106 extends.
- the ring 123 is configured to permit mounting to the trajectory guide assembly 104 in multiple different orientations. This allows repositioning of the reticles 112 A-B about the subject's skull.
- the ring 123 is first mounted such that the reticles 112 A-B are respectively positioned near the left and right sides of the subject's skull.
- Target depth/location confirmation is then performed using this first orientation. Then, the ring 123 is re-oriented such that the reticles 112 A-B are respectively positioned near the front and back sides of the subject's skull. Target depth/location confirmation is then again performed using this second orientation.
- first and second orientations need not be orthogonal. Instead, intermediate orientations are also possible, permitting target depth/location confirmation from different “views.”
- FIG. 2 is a top perspective view illustrating an example of portions of the stereotactic apparatus 100 in more detail.
- the saddle 120 of the trajectory guide assembly 104 includes a stage 200 defining a lumen 202 therethrough.
- the lumen 202 points at the burr hole or other entry portal from different orientations, which are obtained by adjusting the rotational and tilting degrees of freedom of the trajectory guide assembly 104 , as discussed above.
- the lumen 202 receives a multilumen or other insert (not shown in FIG. 2), which provides at least one instrument guide lumen that constrains the instrument 108 being introduced, thereby defining its trajectory 106 .
- the lumen 202 includes teeth 204 , located on a portion of its internal circumference, for engaging corresponding mating teeth on a portion of the external circumference of the guide-lumen-bearing insert that is inserted into the lumen 202 .
- the teeth 204 permit insertion of the guide-lumen-bearing insert into the lumen 202 in a desired one of a plurality of possible orientations defined by engagement with the teeth 204 .
- the ring 123 is seated on four posts 206 A-D (or otherwise seated on any other suitable number of posts or other suitable structures).
- the posts 206 are received within respective rims extending downward from the respective internal and external circumferences of the ring 123 .
- This riding permits the positioning assembly 110 to be rotated to reposition the reticles 112 A-B (e.g., from locations at the front and back of the subject's skull to locations at the left and right sides of the subject's skull, as discussed above).
- the ring 123 includes a plurality of through-holes 208 that are distributed about the circumference of the ring 123 .
- Thumbscrews 210 A-B extend through selected through-holes 208 to secure the ring 123 to the posts 206 with the positioning assembly 110 in the desired orientation for performing the depth confirmation.
- the thumbscrews 210 A-B are removed and re-inserted into different through-holes 208 .
- FIG. 3 is a perspective view schematic diagram that illustrates an example of the stereotactic apparatus 100 in which the ring 123 has been rotated and repositioned by 45° with respect to the position illustrated in FIG. 1.
- the ring 123 includes an inner circumferential rim 212 and an outer circumferential rim 214 .
- the rims 212 and 214 are connected by multiple plates 216 . These plates 216 are distributed about the circumference of the ring 123 .
- the plates 216 assist in providing the ring 123 with sufficient mechanical strength for supporting the radial arms 124 A-B, the side arms 128 A-B, and the reticles 112 A-B.
- the radial arms 124 A-B include I-beams, braces, or other mechanical support structures.
- the ring 123 , the radial arms 124 A-B, and the side arms 128 A-B are made of acetylbutylstyrene (ABS), polycarbonate, or other rigid plastic material. In one example, such materials permit such components to be MR-compatible, sterilizable, and/or disposable.
- FIG. 4 is a side perspective view schematic diagram illustrating an example of portions of the stereotactic apparatus 100 in which the trajectory 106 is coincident with an axis 400 extending substantially concentrically through and orthogonal to a burr hole or other entry portal to or about which the mounting base 102 is secured. Therefore, in the illustration of FIG. 4, the side arms 128 A-B extend longitudinally parallel to both the trajectory 106 and the concentric axis 400 . In this illustration, the sighting line 114 intersects both the trajectory 106 and the concentric axis 400 .
- FIG. 5 is a side perspective view schematic diagram illustrating an example of portions of the stereotactic apparatus 100 in which the trajectory 106 has been tilted (such as by adjusting the position of the saddle 120 on the semispheric arc 122 ) at an angle to the axis 400 .
- the positioning assembly 110 moves along with the saddle 120 portion of the trajectory guide assembly 104 , to which the positioning assembly 104 is attached. Therefore, in the illustration of FIG. 5, the side arms 128 A-B continue to extend parallel to the trajectory 106 (e.g., after the saddle 120 is adjusted), but are no longer parallel to the concentric axis 400 .
- sighting line 114 continues to intersect the trajectory 106 , but no longer intersects the concentric axis 400 .
- sighting line 114 is positioned to confirm depth of the instrument 108 along the trajectory 106 , the orientation of which may be adjusted by the user to intersect the desired target located beyond the burr hole or other entry portal in the surface.
- FIG. 6 is a schematic diagram illustrating conceptually a view of the reticles 112 A-B and the instrument 108 , such as would be seen on the imaging system that is used to confirm placement of the instrument 108 at the desired depth along the trajectory 106 .
- each of reticles 112 A-B includes an imagable target pattern for assisting the user in “sighting” along the sighting line 114 using the imaging system.
- the reticle 112 A includes a “bullseye” pattern of concentric circles about a centerpoint of the reticle 112 A through which the sighting line 114 is defined. These circles are spaced apart at predetermined equal distances.
- the reticle 112 B includes a different pattern than reticle 112 A, thereby allowing the user to distinguish between the two reticles 112 A-B using the display of the imaging system.
- the reticle 112 B includes crosshairs intersecting at a centerpoint of the reticle 112 B through which the sighting line 114 is defined.
- Each crosshair includes orthogonal hashmarks that are spaced at equal predetermined distances from the centerpoint of the reticle 112 B at which the crosshairs intersect.
- the different patterns of reticles 112 A-B make it easier for the user to align the centerpoints of the reticles 112 A-B to “sight” along sighting line 114 using the imaging system.
- Such sighting alignment could also be performed, for example, using a wide variety of other patterns.
- Such patterns may even constitute using only imagable centerpoint locators (e.g., dots) at the centers of reticles 112 A-B. Therefore, neither of imagable reticles 112 A-B need require an imagable network or pattern.
- the reticles 112 A-B include plastic or other disks (which are substantially invisible on the imaging system display), which include wires, arranged into the patterns carried by the disks. If the reticles 112 A-B are intended for use with fluoroscopy or x-ray imaging, then the wires include tungsten, gold, platinum, stainless steel, a dense Noble metal, or other such material providing good radiological image contrast. In various examples, the wires implementing the patterns are molded into the plastic disks, inserted into milled routes in the plastic disks, adhered to the plastic disks, or otherwise affixed to or incorporated in the plastic disks.
- the patterns are printed onto, absorbed into, etched into or otherwise affixed to portions of the plastic or other disks (or onto decals that are adhered thereto).
- these patterns use ink that includes tungsten or similar powder, or that is otherwise formulated to be visible on the imaging system display.
- the patterns are multimodal, that is, they are visible on a plurality of different types of imaging systems (e.g., CT and MR, etc.). At least a portion of the instrument 108 (e.g., the instrument tip) is also constructed to be visible on the display of the particular imaging system used for depth confirmation.
- the reticles 112 A-B include grooves that are milled, etched chemically or using a laser or otherwise, or otherwise formed into the plastic disks to form the patterns.
- the grooves have a thickness between about 0.025 inches and 0.030 inches.
- An epoxy is mixed with tungsten powder (or other radiological or other imagable substance). The epoxy mixture is applied to the plastic disks and introduced into the grooves. The excess epoxy mixture is wiped off, leaving behind only the epoxy mixture that was introduced into the grooves. The resulting patterned epoxy mixture is allowed to harden.
- FIG. 7A illustrates conceptually a side view of the reticles 112 A-B and the instrument 108 , such as would be seen on the imaging system that is used to confirm placement of the instrument 108 at the desired depth along the trajectory 106 .
- the centerpoints of the reticles 112 A-B are nearly aligned with each other.
- FIG. 7B illustrates conceptually a side view of the reticles 112 A-B and the instrument 108 , such as would be seen on the imaging system that is used to confirm placement of the instrument 108 at the desired depth along the trajectory 106 .
- the centerpoints of the reticles 112 A-B are aligned with each other, thereby conceptually defining the sighting line 114 to extend orthogonally into and out of the page illustrating FIG. 7B.
- the concentric circles patterned onto reticle 112 A are spaced 10 millimeters apart from each other.
- the hash marks orthogonally intersecting the crosshairs of reticle 112 B are also spaced 10 millimeters away from each other.
- the imaging system display indicates that the tip of the instrument 108 being introduced along the trajectory 106 is about 2 millimeters short of the desired target to which the centerpoints of the reticles 112 A-B have been adjusted.
- the user may then insert the instrument 108 along the trajectory 106 an additional two millimeters to bring the tip of the instrument 108 to the point at which the trajectory 106 and the sighting line 114 intersect. However, doing so may still not bring the tip of the instrument 108 to the desired target location in 3D space, since target confirmation has been obtained only along the particular sighting line 114 .
- depth confirmation can be obtained along one or more other sighting lines 114 intersecting the trajectory 106 from different directions.
- an instrument 108 having a tip aligned to the first sighting line 114 in FIG. 7B may still be off-target along a second sighting line that is taken orthogonal to the sighting line 114 illustrated in FIG.
- FIG. 8 is a schematic diagram illustrating generally, by way of example, but not by way of limitation, portions of one embodiment of the apparatus 100 in which the side arms 128 A-B are adjustably coupled to the radial arms 124 A-B. This allows the reticles 112 A-B to be moved toward and away from the subject's skull, if desired by the user.
- a slide 800 B rides along the radial arm 124 B until secured by a locking device, such as a thumbscrew 802 B.
- the side arm 128 B slides through a guide portion 804 B of the slide 800 B, thereby allowing depth adjustment of the reticles 112 B using a scale on the side arm 128 B in conjunction with an indicator 806 B on the guide portion 804 B of the slide 800 B.
- the opposing side arm 124 A and radial arm 128 A include a similar slide 800 A.
- FIG. 9 is a flow chart illustrating generally one example of a technique for performing instrument depth confirmation during an image-guided neurosurgery procedure.
- preoperative brain images are obtained using an imaging system, and a target location in the brain is identified.
- the images are used to plan an entry point on the subject's skull.
- the physical location of the subject's skull is registered (i.e., correlated) to the preoperative brain images.
- the planned entry point is located using a frameless surgical navigation alignment wand, or similar techniques, and a burr hole is created at the planned entry point.
- the trajectory guiding stereotactic apparatus 100 is mounted in or about the burr hole.
- the orientation of the trajectory is adjusted, as desired (e.g., by using the rotate and tilt degrees of freedom of trajectory guide 104 , as discussed above), and then fixed.
- the instrument 108 is introduced along the trajectory 106 .
- the positioning apparatus 110 is then coupled to the trajectory guide 104 in a first orientation.
- the positions of the reticles 112 A-B are adjusted to correspond to the desired target depth (e.g., by using the scales on the slots 116 A-B on the respective side arms 128 A-B).
- the reticles 112 A-B are aligned to each other on a display of an intraoperative imaging system (which may be different from the imaging system used to obtain the preoperative images).
- a first error (if any) is read along a first sightline 114 between the centers of the aligned reticles 112 A-B.
- the positioning apparatus 110 is re-oriented with respect to the trajectory guide 104 in a second orientation that is different from the first orientation.
- the reticles 112 A-B are aligned to each other on the imaging system display.
- a second error (if any) is read along a second sightline 114 between the centers of the aligned reticles 112 A-B.
- the instrument 108 is repositioned using the measurements of the first and second errors; this may include readjusting the trajectory provided by stereotactic apparatus 100 , or may simply involve further inserting (or backing off) the instrument 108 .
- FIG. 10 is a top view of an alternative example of a positioning assembly 1000 that includes a semicircular or C-shaped indexing ring 1002 for seating upon, circularly adjusting with respect to, and securing to the trajectory guide assembly 104 .
- the trajectory guide 104 includes an instrument introducer or other possibly bulky equipment mounted to the stage 200 or inserted into the lumen 202 . Because of the open nature of the C-shaped ring 1002 , it may be mounted to (and/or oriented with respect to) the trajectory guide 104 even after such other possibly bulk equipment is already in place.
- the C-shaped indexing ring 1002 may possibly not provide orthogonal first and second sightlines 114 (at least in certain embodiments), even in such embodiments, it still permits a plurality of different orientations for obtaining views along different sightlines 114 for performing separate depth confirmations along such different sightlines 114 .
- FIG. 11 is a schematic diagram illustrating generally a perspective view of a trajectory guide assembly 1100 including an adjustable-height stage 1102 for receiving a multilumen or other insert providing one or more instrument guide lumens defining the trajectory 106 .
- the height of the stage 1102 above the burr hole or other entry portal is adjusted by turning a dial 1104 that engages a threaded portion 1106 of a member supporting the stage 1102 .
- a trajectory guide assembly 1100 is described in Mazzocchi et al. U.S. patent application Ser. No. ______, (Attorney Docket No.
- the stage 1102 includes posts 206 or other suitable structures for receiving and seating a rotatable circular or semicircular ring 123 portion of a positioning assembly 110 that includes imagable depth confirmation locators, such as described above.
- positioning assembly 110 need not include slots or other adjustable coupling of the side arms 128 A-B to the radial arms 124 A. Instead, the stage 1102 is first adjusted to a desired height from the target. Then, an appropriate unitary positioning assembly, with side arms 128 A-B having lengths fabricated to correspond to a particular depth or the like, is selected from a kit of such pre-fabricated positioning assemblies with varying length side arms 128 A-B corresponding to various possible target depths (in one example, the particular depth is printed on the particular assembly, thereby allowing the user to easily select the desired depth). The target depth confirmation is then performed using the particularly selected positioning assembly that corresponds to the desired target depth.
- FIG. 12 is a schematic diagram illustrating generally, by way of example, but not by way of limitation, one embodiment of an alternative trajectory guide assembly 1200 carrying an instrument guide insert 1202 having at least one guide lumen, and including posts 206 or other suitable structures for receiving and seating a rotatable circular or semicircular ring 123 portion of a positioning assembly 110 that includes imagable depth confirmation locators, such as described above.
- Certain portions of the trajectory guide assembly 1200 are described in Matthew Solar's U.S. patent application Ser. No. 10/325,615 (Attorney Docket No. 723.057US1), entitled ORGAN ACCESS DEVICE AND METHOD filed on Dec. 20, 2002, commonly assigned to Image-Guided Neurologics, Inc., which is incorporated herein by reference in its entirety, including its description of portions of a trajectory guide assembly as illustrated in FIG. 12 of the present document.
- FIG. 13 is a schematic diagram illustrating generally, by way of example, but not by way of limitation, another embodiment of an alternative trajectory guide assembly 1300 carrying an instrument guide 1302 that includes at least one guide lumen 1304 and posts 206 or other suitable structures for receiving and seating a rotatable circular or semicircular ring 123 portion of a positioning assembly 110 that includes imagable depth confirmation locators, such as described above.
- Certain portions of trajectory guide assembly 1300 are described in Matthew Solar's U.S. patent application Ser. No. 10/325,615 (Attorney Docket No. 723.057US1), entitled ORGAN ACCESS DEVICE AND METHOD, filed on Dec. 20, 2002, commonly assigned to Image-Guided Neurologics, Inc., which is incorporated herein by reference in its entirety, including its description relevant to a trajectory guide assembly as illustrated in FIG. 13 of the present document.
- FIG. 14 is a schematic diagram illustrating generally, by way of example, but not by way of limitation, another embodiment of an alternative trajectory guide assembly 1400 carrying an instrument guide 1402 having at least one guide lumen 1403 , and having a barrel sleeve portion 1404 that extends into a ball 1406 that is received within a socket 1408 portion of a mounting base 1410 .
- the trajectory guide assembly 1400 also includes posts 206 or other suitable structures for receiving and seating a rotatable circular or semicircular ring 123 portion of a positioning assembly 110 that includes imagable depth confirmation locators, such as described above.
- the ball 1406 is positioned just above a burr hole entry portal.
- Certain portions of trajectory guide assembly 1400 are described Truwit U.S. Pat. No. 6,267,769, which is incorporated herein by reference in its entirety, including its description relevant to a trajectory guide assembly and mounting base as illustrated in FIG. 14 of the present document.
- FIG. 15 is a schematic diagram illustrating generally, by way of example, but not by way of limitation, another embodiment of an alternative trajectory guide assembly 1500 carrying an instrument guide 1502 having at least one guide lumen 1503 , and having a barrel sleeve portion 1504 that extends into a ball 1506 that is received within a socket 1508 portion of a mounting base 1510 .
- the trajectory guide assembly 1500 also includes posts 206 or other suitable structures for receiving and seating a rotatable circular or semicircular ring 123 portion of a positioning assembly 110 that includes imagable depth confirmation locators, such as described above.
- the ball 1506 is positioned at least partially within the burr hole entry portal.
- Certain portions of trajectory guide assembly 1500 are described Truwit U.S. Pat. No. 5,993,463, which is incorporated herein by reference in its entirety, including its description relevant to a trajectory guide assembly and mounting base as illustrated in FIG. 15 of the present document.
- FIG. 16 is an example of a trajectory guide 1600 that is custom-formed (e.g., using known rapid prototyping and tooling techniques and preoperative images of a desired target in a subject) such that an instrument guide 1602 portion of a working platform 1604 includes at least one guide lumen 1606 providing a concentric trajectory 106 directed through the center of a burr hole or other entry portal to intersect a portion of the desired target within the subject.
- a trajectory guide 1600 that is custom-formed (e.g., using known rapid prototyping and tooling techniques and preoperative images of a desired target in a subject) such that an instrument guide 1602 portion of a working platform 1604 includes at least one guide lumen 1606 providing a concentric trajectory 106 directed through the center of a burr hole or other entry portal to intersect a portion of the desired target within the subject.
- the platform 1604 is oriented as desired by custom manufacturing (e.g., tailored to a particular procedure on a particular subject) the size or shape of legs 1608 , which are mounted to the subject's skull, such as by using bone screws extending through holes 1610 through respective feet 1612 extending outwardly from respective legs 1608 .
- the working platform 1604 includes posts 206 or other suitable structures for receiving and seating a rotatable circular or semicircular ring 123 portion of a positioning assembly 110 that includes imagable depth confirmation locators, such as described above.
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Abstract
Description
- This document relates generally to trajectory guides for steering an instrument, and more specifically, but not by way of limitation, to target depth locators for a trajectory guide.
- Neurosurgery sometimes involves inserting an instrument through a burr hole or other entry portal into a subject's brain toward a target region of the brain. Because of the precision needed to reach the target, while avoiding nearby structures that are often critical to brain function, stereotactic instrument guidance is sometimes provided. In one such technique, a stereotactic headframe is mounted about the patient's skull. A trajectory guide is mounted to the headframe to provide an instrument-guiding trajectory through the burr hole and aimed toward the target. In another technique (sometimes referred to as “frameless stereotaxy”), a trajectory guide is locally mounted directly to the skull in or about the burr hole. The skull-mounted trajectory guide also provides an instrument-guiding trajectory through the burr hole and aimed toward the target. In either technique, an image-guided workstation may be used to provide navigational guidance to the neurosurgeon, such as by displaying preoperative images of the subject to assist the neurosurgeon in planning or performing the procedure.
- Among other things, the present inventors have recognized that a neurosurgeon using a trajectory guide to introduce an instrument to a target may want to confirm that the instrument has actually reached the depth of the desired target. For these and other reasons, which will become apparent upon reading the following detailed description and viewing the drawings that form a part thereof, the present inventors have recognized an unmet need for trajectory guide systems, devices, and methods allow confirmation that an instrument being introduced has actually reached the desired target.
- In the drawings, which are not necessarily drawn to scale, like numerals describe substantially similar components throughout the several views. Like numerals having different letter suffixes represent different instances of substantially similar components. The drawings illustrate generally, by way of example, but not by way of limitation, various embodiments discussed in the present document.
- FIG. 1 is a perspective view schematic diagram illustrating generally an example of portions of a stereotactic apparatus.
- FIG. 2 is a top perspective view illustrating an example of portions of the stereotactic apparatus in more detail.
- FIG. 3 is a perspective view schematic diagram that illustrates generally an example of the stereotactic apparatus with the positioning assembly re-oriented by 45° with respect to the position illustrated in FIG. 1.
- FIG. 4 is a side perspective view schematic diagram illustrating generally an example of portions of the stereotactic apparatus in which the trajectory is coincident with an axis extending substantially concentrically through and orthogonal to a burr hole or other entry portal to or about which a mounting base is secured.
- FIG. 5 is a side perspective view schematic diagram illustrating generally an example of portions of the stereotactic apparatus in which the trajectory has been tilted at an angle to an axis extending substantially concentrically through and orthogonal to a burr hole or other entry portal to or about which a mounting base is secured.
- FIG. 6 is a schematic diagram illustrating conceptually a view of reticles and an instrument being introduced along the guided trajectory, such as would be seen on an imaging system used to confirm placement of the instrument at the desired depth along the trajectory.
- FIG. 7A is a schematic diagram that illustrates conceptually a side view of the reticles and the instrument, such as would be seen on the imaging system confirming placement of the instrument at the desired depth along the trajectory.
- FIG. 7B is a schematic diagram that illustrates conceptually a side view of the reticles and the instrument, such as would be seen on the imaging system confirming placement of the instrument at the desired depth along the trajectory.
- FIG. 8 is a schematic diagram illustrating generally portions of one embodiment of an apparatus in which the side arms are adjustably coupled to the radial arms.
- FIG. 9 is a flow chart illustrating generally one example of a technique for performing instrument depth confirmation during an image-guided neurosurgery procedure.
- FIG. 10 is a top view schematic diagram illustrating generally an alternative example of a positioning assembly that includes a semicircular or C-shaped indexing ring.
- FIG. 11 is a schematic diagram illustrating generally a perspective view of a trajectory guide assembly including an adjustable-height stage.
- FIG. 12 is a schematic diagram illustrating generally an alternative trajectory guide assembly including an apparatus for receiving and seating a positioning assembly bearing imagable depth confirmation locators.
- FIG. 13 is a schematic diagram illustrating generally another alternative trajectory guide assembly including an apparatus for receiving and seating a positioning assembly that includes imagable depth confirmation locators.
- FIG. 14 is a schematic diagram illustrating generally a first ball-and-socket type trajectory guide assembly that includes an apparatus for receiving and seating a positioning assembly that includes imagable depth confirmation locators.
- FIG. 15 is a schematic diagram illustrating generally a second ball-and-socket type trajectory guide assembly that includes an apparatus for receiving and seating a positioning assembly that includes imagable depth confirmation locators.
- FIG. 16 is a schematic diagram illustrating generally an example of a custom-formed trajectory guide that includes an apparatus for receiving and seating a positioning assembly that includes imagable depth confirmation locators.
- In the following detailed description, reference is made to the accompanying drawings that form a part hereof, and in which is shown by way of illustration specific embodiments in which the invention may be practiced. These embodiments are described in sufficient detail to enable those skilled in the art to practice the invention, and it is to be understood that the embodiments may be combined, or that other embodiments may be utilized and that structural, logical and electrical changes may be made without departing from the scope of the present invention. The following detailed description is, therefore, not to be taken in a limiting sense, and the scope of the present invention is defined by the appended claims and their equivalents.
- In this document, the terms “a” or “an” are used, as is common in patent documents, to include one or more than one. Furthermore, all publications, patents, and patent documents referred to in this document are incorporated by reference herein in their entirety, as though individually incorporated by reference. In the event of inconsistent usages between this documents and those documents so incorporated by reference, the usage in the incorporated reference(s) should be considered supplementary to that of this document; for irreconcilable inconsistencies, the usage in this document controls.
- FIG. 1 is a perspective view schematic diagram illustrating generally, by way of example, but not by way of limitation, portions of a
stereotactic apparatus 100. In this example, thestereotactic apparatus 100 includes amounting base 102 and atrajectory guide assembly 104 coupled to themounting base 102. Themounting base 102 is configured, in this example, to be secured in or about a burr hole in a subject's skull (or in or about another entry portal in another surface of an animate or inanimate object). In this example, thetrajectory guide assembly 104 is adjustably orientable with respect to themounting base 102. Thetrajectory guide assembly 104 provides an adjustablyorientable trajectory 106. Along thistrajectory 106, a catheter, an electrode, or anotherinstrument 108 is guided through the entry portal toward a target located beyond the surface. Apositioning assembly 110 is coupled to thetrajectory guide assembly 104. In this example, thepositioning assembly 110 carries imagable locators, such asimagable reticles 112A-B (also referred to as “reticules”). Such imagable locators are used for confirming, using an imaging system to locate the locators, that theinstrument 108 introduced along thetrajectory 106 has reached a desired depth or other desired location corresponding to a desired target. Examples of suitable imaging systems include, by way of example, but not by way of limitation, magnetic resonance (MR) imaging systems, computed tomography (CT), positron emission tomography (PET), and single photon emission computed tomography (SPECT), X-ray, fluoroscopy, or other radiographic imaging systems, ultrasonic imaging systems, and the like. - In this example, the
positioning assembly 110 is coupled to thetrajectory guide assembly 104 such that a “sighting”line 114, conceptually defined between centers ofreticles 112A-B. Thesighting line 114 intersects thetrajectory 106—even as thetrajectory guide assembly 104 is adjusted, with respect to the fixedmounting base 102, to orient thetrajectory 106. In this example, thepositioning assembly 110 further includes at least one positioner, such as scaledslots 116A-B. A scale accompanying each of therespective slots 116A-B includes viewable indicia providing depth information. - The
slots 116A-B permit adjustment of the locations of thereticles 112A-B such that thesighting line 114 can be adjusted to intersect thetrajectory 106 at different points. In one example, thesighting line 114 is adjusted to intersect thetrajectory 106 at a depth that corresponds to a desired target location in the subject's brain. Thus, by “sighting” along sighting line 114 (i.e., using the imaging system), the user can confirm whether theinstrument 108 has reached the desired target depth, along thetrajectory 106. More particularly, theinstrument 108 will have reached the desired target depth along thetrajectory 106 when the imaging system detects the tip (or other imagable indicator locatable by the imaging system) on theinstrument 108 as being coincident with thesighting line 114. - In the example of FIG. 1, the
positioning assembly 110, carrying thereticles 112A-B for confirming the depth of theinstrument 108, is coupled to an adjustably orientabletrajectory guide assembly 104 that adjusts the trajectory 106 (for introducing the instrument 108) by separately adjusting (1) a rotation about an axis that is concentric and orthogonal to the burr hole or other entry portal in or about which themounting base 102 is secured, and (2) a tilting of an instrument guide lumen (or lumens) to adjust an angle between theinstrument trajectory 106 and the concentric axis. In one example, as illustrated iri FIG. 1, thetrajectory guide assembly 104 rotatably rides on aplatform ring 118, provided by themounting base 102. This provides the rotational adjustment about the concentric axis. In this example, thetrajectory guide assembly 104 further includes a “saddle” 120 riding along a semispheric arc-shaped surface 122. This provides the tilting adjustment of the angle of thetrajectory 106 with respect to the concentric axis. One example of portions of a suitabletrajectory guide assembly 104 andmounting base 102 is described in Skakoon et al. U.S. patent application Ser. No. 09/828,451 entitled “DEEP ORGAN ACCESS DEVICE AND METHOD,” which was filed on Apr. 6, 2001, and which is incorporated herein by reference in its entirety, including its disclosure of trajectory guide structures and methods. In one example, thestereotactic apparatus 100 providesmultiple trajectories 106, such as by using a multilumen insert, one example of which is described in the above-incorporated Skakoon et al. U.S. patent application Ser. No. 09/828,451. - In the example of FIG. 1, the
positioning assembly 100 is detachably mounted to thetrajectory guide assembly 110 using an indexing circular orsemicircular ring 123. In FIG. 1, thering 123 is mounted to thetrajectory guide assembly 104 substantially concentrically to thetrajectory 106 provided by thetrajectory guide assembly 104. In the illustrated example, elongatedradial arms 124A-B radially extend out from opposing sides of the outer circumference of thering 123, such that a line 126 (which is conceptually defined to extend longitudinally through both of the longitudinally-alignedradial arms 124A-B) orthogonally intersects thetrajectory 106. In this example,elongated side arms 128A-B extend orthogonally downward from the outer ends (i.e., the ends that are located away from thering 123 and the trajectory guide assembly 104) of the respectiveradial arms 124A-B. Theside arms 128A-B are oriented, with respect to the respectiveradial arms 124A-B, such that theside arms 128A-B longitudinally extend parallel to thetrajectory 106. In this example, the outer ends (i.e., away from the respectiveradial arms 124A-B) of theside arms 128A-B carry disk-shapedimagable reticles 112A-B, or other imagable locators. In this example, theside arms 128A-B each includerespective slots 116A-B into which slidingend blocks 117A-B of theradial arms 124A-B are inserted. This permits theside arms 128A-B to slide up and down with respect to theradial arms 124A-B, for adjusting thereticles 112A-B toward and away from theradial arms 124A-B. Theslots 116A-B include respective depth scales or other indicia. This permits adjustment ofreticles 112A-B such that thesighting line 114 corresponds to the desired target depth along thetrajectory 106. A locking mechanism, such asthumbscrews 130A-B or the like, extends through each one of theslots 116A-B. This permits thisside arms 128A-B to be secured with respect to theradial arms 124A-B. This, in turn, permits thereticles 112A-B to be securely positioned such that thesighting line 114 intersects thetrajectory 106 at an appropriate point along thetrajectory 106 that corresponds to the desired target depth along thetrajectory 106. - In one example of use, with the mounting
base 102 locally secured to a subject's skull (e.g., in or about a burr hole in the skull), theradial arms 124A-B and theside arms 128A-B position thereticles 112A-B on opposing sides of the subject's skull, into which thetrajectory 106 extends. In a further example, thering 123 is configured to permit mounting to thetrajectory guide assembly 104 in multiple different orientations. This allows repositioning of thereticles 112A-B about the subject's skull. In one such example, thering 123 is first mounted such that thereticles 112A-B are respectively positioned near the left and right sides of the subject's skull. Target depth/location confirmation is then performed using this first orientation. Then, thering 123 is re-oriented such that thereticles 112A-B are respectively positioned near the front and back sides of the subject's skull. Target depth/location confirmation is then again performed using this second orientation. However, such first and second orientations need not be orthogonal. Instead, intermediate orientations are also possible, permitting target depth/location confirmation from different “views.” - FIG. 2 is a top perspective view illustrating an example of portions of the
stereotactic apparatus 100 in more detail. In this example, thesaddle 120 of thetrajectory guide assembly 104 includes astage 200 defining alumen 202 therethrough. Thelumen 202 points at the burr hole or other entry portal from different orientations, which are obtained by adjusting the rotational and tilting degrees of freedom of thetrajectory guide assembly 104, as discussed above. Thelumen 202 receives a multilumen or other insert (not shown in FIG. 2), which provides at least one instrument guide lumen that constrains theinstrument 108 being introduced, thereby defining itstrajectory 106. In this example, thelumen 202 includesteeth 204, located on a portion of its internal circumference, for engaging corresponding mating teeth on a portion of the external circumference of the guide-lumen-bearing insert that is inserted into thelumen 202. Theteeth 204 permit insertion of the guide-lumen-bearing insert into thelumen 202 in a desired one of a plurality of possible orientations defined by engagement with theteeth 204. - In the example of FIG. 2, the
ring 123 is seated on fourposts 206A-D (or otherwise seated on any other suitable number of posts or other suitable structures). In this example, theposts 206 are received within respective rims extending downward from the respective internal and external circumferences of thering 123. This allows thering 123 to circularly ride upon theposts 206A-D. This riding permits thepositioning assembly 110 to be rotated to reposition thereticles 112A-B (e.g., from locations at the front and back of the subject's skull to locations at the left and right sides of the subject's skull, as discussed above). - In this example, the
ring 123 includes a plurality of through-holes 208 that are distributed about the circumference of thering 123.Thumbscrews 210A-B extend through selected through-holes 208 to secure thering 123 to theposts 206 with thepositioning assembly 110 in the desired orientation for performing the depth confirmation. To reposition thepositioning assembly 110 in a different orientation, thethumbscrews 210A-B are removed and re-inserted into different through-holes 208. FIG. 3 is a perspective view schematic diagram that illustrates an example of thestereotactic apparatus 100 in which thering 123 has been rotated and repositioned by 45° with respect to the position illustrated in FIG. 1. - In the example illustrated in FIG. 2, the
ring 123 includes an innercircumferential rim 212 and an outercircumferential rim 214. Therims multiple plates 216. Theseplates 216 are distributed about the circumference of thering 123. Theplates 216 assist in providing thering 123 with sufficient mechanical strength for supporting theradial arms 124A-B, theside arms 128A-B, and thereticles 112A-B. Similarly, theradial arms 124A-B include I-beams, braces, or other mechanical support structures. This provides sufficient mechanical strength for supporting and positioning theside arms 128A-B and thereticles 112A-B with the desired degree of accuracy for verifying that theinstrument 108 has reached the desired target depth. In one example, thering 123, theradial arms 124A-B, and theside arms 128A-B are made of acetylbutylstyrene (ABS), polycarbonate, or other rigid plastic material. In one example, such materials permit such components to be MR-compatible, sterilizable, and/or disposable. - FIG. 4 is a side perspective view schematic diagram illustrating an example of portions of the
stereotactic apparatus 100 in which thetrajectory 106 is coincident with anaxis 400 extending substantially concentrically through and orthogonal to a burr hole or other entry portal to or about which the mountingbase 102 is secured. Therefore, in the illustration of FIG. 4, theside arms 128A-B extend longitudinally parallel to both thetrajectory 106 and theconcentric axis 400. In this illustration, thesighting line 114 intersects both thetrajectory 106 and theconcentric axis 400. - By contrast, FIG. 5 is a side perspective view schematic diagram illustrating an example of portions of the
stereotactic apparatus 100 in which thetrajectory 106 has been tilted (such as by adjusting the position of thesaddle 120 on the semispheric arc 122) at an angle to theaxis 400. Thepositioning assembly 110 moves along with thesaddle 120 portion of thetrajectory guide assembly 104, to which thepositioning assembly 104 is attached. Therefore, in the illustration of FIG. 5, theside arms 128A-B continue to extend parallel to the trajectory 106 (e.g., after thesaddle 120 is adjusted), but are no longer parallel to theconcentric axis 400. Consequently, in this illustration, thesighting line 114 continues to intersect thetrajectory 106, but no longer intersects theconcentric axis 400. In this manner,sighting line 114 is positioned to confirm depth of theinstrument 108 along thetrajectory 106, the orientation of which may be adjusted by the user to intersect the desired target located beyond the burr hole or other entry portal in the surface. - FIG. 6 is a schematic diagram illustrating conceptually a view of the
reticles 112A-B and theinstrument 108, such as would be seen on the imaging system that is used to confirm placement of theinstrument 108 at the desired depth along thetrajectory 106. In the illustration of FIG. 6, each ofreticles 112A-B includes an imagable target pattern for assisting the user in “sighting” along thesighting line 114 using the imaging system. In the example illustrated in FIG. 6, thereticle 112A includes a “bullseye” pattern of concentric circles about a centerpoint of thereticle 112A through which thesighting line 114 is defined. These circles are spaced apart at predetermined equal distances. In this example, thereticle 112B includes a different pattern thanreticle 112A, thereby allowing the user to distinguish between the tworeticles 112A-B using the display of the imaging system. For example, in the illustration of FIG. 6, thereticle 112B includes crosshairs intersecting at a centerpoint of thereticle 112B through which thesighting line 114 is defined. Each crosshair includes orthogonal hashmarks that are spaced at equal predetermined distances from the centerpoint of thereticle 112B at which the crosshairs intersect. The different patterns ofreticles 112A-B make it easier for the user to align the centerpoints of thereticles 112A-B to “sight” alongsighting line 114 using the imaging system. However, such sighting alignment could also be performed, for example, using a wide variety of other patterns. Such patterns may even constitute using only imagable centerpoint locators (e.g., dots) at the centers ofreticles 112A-B. Therefore, neither ofimagable reticles 112A-B need require an imagable network or pattern. - In one example, the
reticles 112A-B include plastic or other disks (which are substantially invisible on the imaging system display), which include wires, arranged into the patterns carried by the disks. If thereticles 112A-B are intended for use with fluoroscopy or x-ray imaging, then the wires include tungsten, gold, platinum, stainless steel, a dense Noble metal, or other such material providing good radiological image contrast. In various examples, the wires implementing the patterns are molded into the plastic disks, inserted into milled routes in the plastic disks, adhered to the plastic disks, or otherwise affixed to or incorporated in the plastic disks. - In another example, the patterns are printed onto, absorbed into, etched into or otherwise affixed to portions of the plastic or other disks (or onto decals that are adhered thereto). In one such example, these patterns use ink that includes tungsten or similar powder, or that is otherwise formulated to be visible on the imaging system display. In yet a further example, the patterns are multimodal, that is, they are visible on a plurality of different types of imaging systems (e.g., CT and MR, etc.). At least a portion of the instrument108 (e.g., the instrument tip) is also constructed to be visible on the display of the particular imaging system used for depth confirmation.
- In yet another manufacturing example, the
reticles 112A-B include grooves that are milled, etched chemically or using a laser or otherwise, or otherwise formed into the plastic disks to form the patterns. In one example, the grooves have a thickness between about 0.025 inches and 0.030 inches. An epoxy is mixed with tungsten powder (or other radiological or other imagable substance). The epoxy mixture is applied to the plastic disks and introduced into the grooves. The excess epoxy mixture is wiped off, leaving behind only the epoxy mixture that was introduced into the grooves. The resulting patterned epoxy mixture is allowed to harden. - FIG. 7A illustrates conceptually a side view of the
reticles 112A-B and theinstrument 108, such as would be seen on the imaging system that is used to confirm placement of theinstrument 108 at the desired depth along thetrajectory 106. In this example, the centerpoints of thereticles 112A-B are nearly aligned with each other. - FIG. 7B illustrates conceptually a side view of the
reticles 112A-B and theinstrument 108, such as would be seen on the imaging system that is used to confirm placement of theinstrument 108 at the desired depth along thetrajectory 106. In this example, the centerpoints of thereticles 112A-B are aligned with each other, thereby conceptually defining thesighting line 114 to extend orthogonally into and out of the page illustrating FIG. 7B. In this example, the concentric circles patterned ontoreticle 112A are spaced 10 millimeters apart from each other. Similarly, the hash marks orthogonally intersecting the crosshairs ofreticle 112B are also spaced 10 millimeters away from each other. - In the example illustrated in FIG. 7B, the imaging system display indicates that the tip of the
instrument 108 being introduced along thetrajectory 106 is about 2 millimeters short of the desired target to which the centerpoints of thereticles 112A-B have been adjusted. The user may then insert theinstrument 108 along thetrajectory 106 an additional two millimeters to bring the tip of theinstrument 108 to the point at which thetrajectory 106 and thesighting line 114 intersect. However, doing so may still not bring the tip of theinstrument 108 to the desired target location in 3D space, since target confirmation has been obtained only along theparticular sighting line 114. But, by circularly rotating thepositioning apparatus 110 about the trajectory 106 (such as by using thethumbscrews 210A-B and the particularly selected through-holes 208 of the ring 123) depth confirmation can be obtained along one or moreother sighting lines 114 intersecting thetrajectory 106 from different directions. For example, aninstrument 108 having a tip aligned to thefirst sighting line 114 in FIG. 7B may still be off-target along a second sighting line that is taken orthogonal to thesighting line 114 illustrated in FIG. 7B (e.g., by rotatably repositioning the ring 123), in which case theinstrument 108 would appear to the right or left of the commonly aligned centerpoints of thereticles 112A-D along that second sighting line. - FIG. 8 is a schematic diagram illustrating generally, by way of example, but not by way of limitation, portions of one embodiment of the
apparatus 100 in which theside arms 128A-B are adjustably coupled to theradial arms 124A-B. This allows thereticles 112A-B to be moved toward and away from the subject's skull, if desired by the user. In the example illustrated in FIG. 8, aslide 800B rides along theradial arm 124B until secured by a locking device, such as athumbscrew 802B. Moreover, in the illustrated example, theside arm 128B slides through aguide portion 804B of theslide 800B, thereby allowing depth adjustment of thereticles 112B using a scale on theside arm 128B in conjunction with an indicator 806B on theguide portion 804B of theslide 800B. Although not shown in the close-up view illustrated in FIG. 8, in this embodiment, the opposingside arm 124A andradial arm 128A include a similar slide 800A. - FIG. 9 is a flow chart illustrating generally one example of a technique for performing instrument depth confirmation during an image-guided neurosurgery procedure. At900, preoperative brain images are obtained using an imaging system, and a target location in the brain is identified. At 902, the images are used to plan an entry point on the subject's skull. At 904, the physical location of the subject's skull is registered (i.e., correlated) to the preoperative brain images. At 906, the planned entry point is located using a frameless surgical navigation alignment wand, or similar techniques, and a burr hole is created at the planned entry point. At 908, the trajectory guiding
stereotactic apparatus 100 is mounted in or about the burr hole. At 910, the orientation of the trajectory is adjusted, as desired (e.g., by using the rotate and tilt degrees of freedom oftrajectory guide 104, as discussed above), and then fixed. At 912, theinstrument 108 is introduced along thetrajectory 106. At 914, thepositioning apparatus 110 is then coupled to thetrajectory guide 104 in a first orientation. At 916, the positions of thereticles 112A-B are adjusted to correspond to the desired target depth (e.g., by using the scales on theslots 116A-B on therespective side arms 128A-B). At 918, thereticles 112A-B are aligned to each other on a display of an intraoperative imaging system (which may be different from the imaging system used to obtain the preoperative images). At 920, a first error (if any) is read along afirst sightline 114 between the centers of the alignedreticles 112A-B. At 922, thepositioning apparatus 110 is re-oriented with respect to thetrajectory guide 104 in a second orientation that is different from the first orientation. At 924, thereticles 112A-B are aligned to each other on the imaging system display. At 926, a second error (if any) is read along asecond sightline 114 between the centers of the alignedreticles 112A-B. At 928, theinstrument 108 is repositioned using the measurements of the first and second errors; this may include readjusting the trajectory provided bystereotactic apparatus 100, or may simply involve further inserting (or backing off) theinstrument 108. - FIG. 10 is a top view of an alternative example of a
positioning assembly 1000 that includes a semicircular or C-shapedindexing ring 1002 for seating upon, circularly adjusting with respect to, and securing to thetrajectory guide assembly 104. This is advantageous, for example, in an embodiment in which thetrajectory guide 104 includes an instrument introducer or other possibly bulky equipment mounted to thestage 200 or inserted into thelumen 202. Because of the open nature of the C-shapedring 1002, it may be mounted to (and/or oriented with respect to) thetrajectory guide 104 even after such other possibly bulk equipment is already in place. Although the C-shapedindexing ring 1002 may possibly not provide orthogonal first and second sightlines 114 (at least in certain embodiments), even in such embodiments, it still permits a plurality of different orientations for obtaining views alongdifferent sightlines 114 for performing separate depth confirmations along suchdifferent sightlines 114. - Although the above examples emphasized verifying whether an instrument has reached a desired target depth along a
trajectory 106 using a positioning assembly with imagable locators together with atrajectory guide assembly 104 having separate “rotate” and “tilt” degrees of freedom, the described instrument depth verification devices and techniques apply to a wide variety of other locally-mounted trajectory guides providing an adjustably orientable instrument-guiding trajectory. - For example, FIG. 11 is a schematic diagram illustrating generally a perspective view of a
trajectory guide assembly 1100 including an adjustable-height stage 1102 for receiving a multilumen or other insert providing one or more instrument guide lumens defining thetrajectory 106. The height of thestage 1102 above the burr hole or other entry portal is adjusted by turning adial 1104 that engages a threadedportion 1106 of a member supporting thestage 1102. One example of aspects of such atrajectory guide assembly 1100 is described in Mazzocchi et al. U.S. patent application Ser. No. ______, (Attorney Docket No. 723.062US1), entitled “TRAJECTORY GUIDE WITH ANGLED OR PATTERNED GUIDE LUMENS OR HEIGHT ADJUSTMENT,” filed on even date herewith, which is incorporated herein by reference in its entirety, including its description of height adjustment for a locally-mounted adjustably orientable trajectory guide. In FIG. 11, thestage 1102 includesposts 206 or other suitable structures for receiving and seating a rotatable circular orsemicircular ring 123 portion of apositioning assembly 110 that includes imagable depth confirmation locators, such as described above. - Moreover, in one such height adjustable trajectory guide embodiment,
positioning assembly 110 need not include slots or other adjustable coupling of theside arms 128A-B to theradial arms 124A. Instead, thestage 1102 is first adjusted to a desired height from the target. Then, an appropriate unitary positioning assembly, withside arms 128A-B having lengths fabricated to correspond to a particular depth or the like, is selected from a kit of such pre-fabricated positioning assemblies with varyinglength side arms 128A-B corresponding to various possible target depths (in one example, the particular depth is printed on the particular assembly, thereby allowing the user to easily select the desired depth). The target depth confirmation is then performed using the particularly selected positioning assembly that corresponds to the desired target depth. - FIG. 12 is a schematic diagram illustrating generally, by way of example, but not by way of limitation, one embodiment of an alternative
trajectory guide assembly 1200 carrying an instrument guide insert 1202 having at least one guide lumen, and includingposts 206 or other suitable structures for receiving and seating a rotatable circular orsemicircular ring 123 portion of apositioning assembly 110 that includes imagable depth confirmation locators, such as described above. Certain portions of thetrajectory guide assembly 1200 are described in Matthew Solar's U.S. patent application Ser. No. 10/325,615 (Attorney Docket No. 723.057US1), entitled ORGAN ACCESS DEVICE AND METHOD filed on Dec. 20, 2002, commonly assigned to Image-Guided Neurologics, Inc., which is incorporated herein by reference in its entirety, including its description of portions of a trajectory guide assembly as illustrated in FIG. 12 of the present document. - FIG. 13 is a schematic diagram illustrating generally, by way of example, but not by way of limitation, another embodiment of an alternative
trajectory guide assembly 1300 carrying aninstrument guide 1302 that includes at least one guide lumen 1304 andposts 206 or other suitable structures for receiving and seating a rotatable circular orsemicircular ring 123 portion of apositioning assembly 110 that includes imagable depth confirmation locators, such as described above. Certain portions oftrajectory guide assembly 1300 are described in Matthew Solar's U.S. patent application Ser. No. 10/325,615 (Attorney Docket No. 723.057US1), entitled ORGAN ACCESS DEVICE AND METHOD, filed on Dec. 20, 2002, commonly assigned to Image-Guided Neurologics, Inc., which is incorporated herein by reference in its entirety, including its description relevant to a trajectory guide assembly as illustrated in FIG. 13 of the present document. - FIG. 14 is a schematic diagram illustrating generally, by way of example, but not by way of limitation, another embodiment of an alternative
trajectory guide assembly 1400 carrying aninstrument guide 1402 having at least oneguide lumen 1403, and having abarrel sleeve portion 1404 that extends into aball 1406 that is received within asocket 1408 portion of a mountingbase 1410. Thetrajectory guide assembly 1400 also includesposts 206 or other suitable structures for receiving and seating a rotatable circular orsemicircular ring 123 portion of apositioning assembly 110 that includes imagable depth confirmation locators, such as described above. In this example, theball 1406 is positioned just above a burr hole entry portal. Certain portions oftrajectory guide assembly 1400 are described Truwit U.S. Pat. No. 6,267,769, which is incorporated herein by reference in its entirety, including its description relevant to a trajectory guide assembly and mounting base as illustrated in FIG. 14 of the present document. - FIG. 15 is a schematic diagram illustrating generally, by way of example, but not by way of limitation, another embodiment of an alternative
trajectory guide assembly 1500 carrying aninstrument guide 1502 having at least oneguide lumen 1503, and having abarrel sleeve portion 1504 that extends into aball 1506 that is received within asocket 1508 portion of a mountingbase 1510. Thetrajectory guide assembly 1500 also includesposts 206 or other suitable structures for receiving and seating a rotatable circular orsemicircular ring 123 portion of apositioning assembly 110 that includes imagable depth confirmation locators, such as described above. In this example, theball 1506 is positioned at least partially within the burr hole entry portal. Certain portions oftrajectory guide assembly 1500 are described Truwit U.S. Pat. No. 5,993,463, which is incorporated herein by reference in its entirety, including its description relevant to a trajectory guide assembly and mounting base as illustrated in FIG. 15 of the present document. - FIG. 16 is an example of a trajectory guide1600 that is custom-formed (e.g., using known rapid prototyping and tooling techniques and preoperative images of a desired target in a subject) such that an
instrument guide 1602 portion of aworking platform 1604 includes at least oneguide lumen 1606 providing aconcentric trajectory 106 directed through the center of a burr hole or other entry portal to intersect a portion of the desired target within the subject. In one example, theplatform 1604 is oriented as desired by custom manufacturing (e.g., tailored to a particular procedure on a particular subject) the size or shape oflegs 1608, which are mounted to the subject's skull, such as by using bone screws extending throughholes 1610 throughrespective feet 1612 extending outwardly fromrespective legs 1608. In this example, the workingplatform 1604 includesposts 206 or other suitable structures for receiving and seating a rotatable circular orsemicircular ring 123 portion of apositioning assembly 110 that includes imagable depth confirmation locators, such as described above. - The techniques discussed herein may also be useful for accessing locations within any material, particularly where access to the material is limited by a finite-sized entry portal. It is to be understood that the above description is intended to be illustrative, and not restrictive. For example, the above-described embodiments may be used in combination with each other. Many other embodiments will be apparent to those of skill in the art upon reviewing the above description. The scope of the invention should, therefore, be determined with reference to the appended claims, along with the full scope of equivalents to which such claims are entitled. In the appended claims, the terms “including” and “in which” are used as the plain-English equivalents of the respective terms “comprising” and “wherein.” Moreover, in the following claims, the terms “first,” “second,” and “third,” etc. are used merely as labels, and are not intended to impose numerical requirements on their objects.
Claims (40)
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US10/370,083 US7559935B2 (en) | 2003-02-20 | 2003-02-20 | Target depth locators for trajectory guide for introducing an instrument |
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